Dear Dr. Milrod:

I have found that I have a hard time sustaining an erection while lying down, for example, when my partner is on top or similar. However, in missionary, doggie or other positions when I am standing or on top, I am good to go. I don’t think this is psychological. I have no medical credentials, but could this have something to do with blood flow to my penis, meaning “downhill” versus “uphill” flow?  Seems like I have situational erectile dysfunction. I don’t really want to resort to ED medications. What is this?

Upham

Dear Upham:

Your hypothesis does affirm some recent research. Traditionally, physicians concerned about blood flow during sexual intercourse have recommended a sex position with the woman on top. Actual studies that have measured blood flow and heart rate during intercourse have not found this position to be any better than others. In terms of propulsion, however, you will get much better thrust if you are actively using your pelvic muscles rather than just lying down. So keep thrusting away until further notice.

Christine Milrod, Ph.D.